title: Effects of depletion of leukocytes and platelets on cardiac dysfunction after cardiopulmonary bypass.
abstract: BACKGROUND
  This study examined the effects of the depletion of leukocytes and platelets from circulated blood on cardiac function after cardiopulmonary bypass in 37 patients who underwent coronary artery bypass grafting or aortic valve replacement.
  
  
  METHODS
  Leukocytes and platelets were removed continuously using a blood cell separator, beginning immediately after the start of the operation and ending 1 hour after the release of the aortic cross-clamp in 19 patients (LPD group), but not in the remaining 18 patients (control group). Blood cell counts and levels of thromboxane B2, 6-keto-prostaglandin F1alpha, leukocyte elastase, complements C3a and C4a, thrombin-antithrombin III complex, and D-dimer were determined periodically during and after the operation. The cardiac index, the difference between the central and peripheral core temperatures, and the doses of catecholamines and vasodilators required to support the circulation in the early postoperative period also were assessed.
  
  
  RESULTS
  Leukocyte and platelet counts and levels of leukocyte elastase, thromboxane B2, thromboxane2/6-ketoprostaglandin F1alpha, thrombin-antithrombin III complex, and D-dimer were significantly lower in the LPD group than in the control group before and after the release of the aortic cross-clamp and during the perioperative period. There were no significant differences in the levels of 6-keto-prostaglandin F1alpha or complements C3a and C4a between the two groups. The catecholamine dose was significantly lower in the LPD group than in the control group (1.1 +/- 2.5 versus 5.0 +/- 5.2 mg/kg, respectively). Fewer patients required the use of nitroprusside as a vasodilator in the LPD group than in the control group (1/19 versus 12/18, respectively).
  
  
  CONCLUSIONS
  The depletion of leukocytes and platelets using a blood cell separator prevents the deterioration of cardiac function after cardiac operations using cardiopulmonary bypass.
authors.affiliation: The Second Department of Surgery, Fukui Medical School, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Chiba
authors.forename: K
authors.initials: K
authors.lastname: Morioka
authors.forename: R
authors.initials: R
authors.lastname: Muraoka
authors.forename: A
authors.initials: A
authors.lastname: Ihaya
authors.forename: T
authors.initials: T
authors.lastname: Kimura
authors.forename: T
authors.initials: T
authors.lastname: Uesaka
authors.forename: T
authors.initials: T
authors.lastname: Tsuda
authors.forename: K
authors.initials: K
authors.lastname: Matsuyama
mesh_terms: D015121:6-Ketoprostaglandin F1 alpha / Q000097:blood; D000368:Aged; D001021:Aortic Valve; D002315:Cardiopulmonary Bypass; D002395:Catecholamines / Q000008:administration & dosage; D015926:Complement C3a / Q000032:analysis; D015934:Complement C4a / Q000032:analysis; D001026:Coronary Artery Bypass; D005260:Female; D006321:Heart / Q000502:physiology*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007937:Leukapheresis; D007958:Leukocyte Count; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D010976:Platelet Count; D010983:Plateletpheresis; D013929:Thromboxane B2 / Q000097:blood
chemical_list: D002395:Catecholamines; D013929:Thromboxane B2; D015121:6-Ketoprostaglandin F1 alpha; D015926:Complement C3a; D015934:Complement C4a; D019272:Leukocyte Elastase